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May 2016

2018 MIDTERM ELECTION

Not much to say about the bluegrass state...taken together, the 6 carriers offering individual policies in Kentucky appear to be requesting an average rate hike of 23.8%, ranging from Aetna's single-digits for a few hundred people up to Golden Rule's stroke-inducing 65% hike. One thing to note is that KY's total individual market was around 163,000 people in 2015, and is likely around 25% higher today (around 203,000), so over half of the market is likely missing from this table:

With only 584,000 residents, Wyoming is the smallest state, with a population over 10% smaller than even the District of Columbia or Vermont. Last year there were only 2 insurance carriers offering individual policies on the ACA exchange, Blue Cross and WINhealth. The average rate increase for 2016 was right around 10% even.

WINhealth sent along this release saying: As of October 8, 2015, WINhealth has chosen not to participate in the individual market, to include the federal exchange, for the 2016 plan year. The decision not to participate stems from a recent announcement from the federal government regarding the risk corridor program .

Last year, the Texas ACA-compliant individual market carriers requested an average rate hike of around 16%, although it was a pretty fuzzy guesstimate since I couldn't track down the average rate hikes for about 25% of the market other than knowing that whatever it was, it was under 10%.

This year, the good news is that CMS has started postingall rate change requests whether over or under 10%, making it easier to fill in some of the data. The bad news is that 3 of the 19 carriers offering individual policies next year redacted any data giving a clue as to what their current enrollment numbers are: CHRISTUS, Community First and Oscar Insurance.

The other 16 carriers did provide those numbers pretty clearly (except for Sendero, which only gave a projection of "member months" which I had to divide by 12 to get a rough enrollment estimate).

When the dust settled, there were 11 Co-Ops left standing, but most of them were still on pretty shaky ground, with all but a handful placed under "enhanced oversight" by their states (and I have to admit that the term sounds an awful lot like a euphamism, a la "enhanced interrogation technique").

Last year, the insurance carriers in Pennsylvania asked for a weighted average 15.6% rate increase for individual market policies...but in the end state regulators knocked these down by over 1/5th to around 12% overall.

This year the picture is uglier, as expected. While four of the filings are for rate hikes of under 10%, this is misleading because one of them appears to be brand new while the other 3 have a combined enrollment of...7 people. Not 7,000, not 700...seven.

The rest of the filings range from 16% to a whopping 48% increase request from Highmark Health Insurance for over 20,000 enrollees. Ouch.

Overall, the weighted state-wide average requested rate hike on the individual exchange is 23.6%.

The good news about estimating the DC exchange rate hike requests is that the DC Dept. of Insurance, Securities & Banking is pretty transparent about posting this info, and they keep it simple. It's simpler still because like Vermont, DC requires that all individual and small group policies be sold on the exchange, so there's no off-exchange data to track down.

The bad news is that it's a little bit too simple: Only two carriers (CareFrist and Kaiser) offer policies via the individual exchange, and only CareFirst is offering PPOs:

...in terms of following the requirements of the HHS Dept, it's very useful for people to look up their particular company in their state, see what their "average" rate increase request is and submit cranky public comments (which will in most cases probably be ignored, but hey, you never know).

And yes, this certainly makes it easier to fill in some of the missing pieces of the puzzle, and helps cut down on how much hunting around people like myself have to do to track down some of this data. For that alone, I'm extremely glad to see this tool added.

Last year, Indiana was one of only two states to see virtually flat year over year premium increases on the ACA-compliant individual market, with rates going up a mere 0.7% on average. This year, unfortunately, that won't be the case...although at least one carrier, Celtic, is reducing their average rates by over 5%.

The good news is that I was able to track down the average rate change for all 6 carriers offering individual plans in Indiana (UnitedHealthcare is dropping out of the market, and I'm not sure what's going on with Aetna and Coordinated Care Corporation, both of which do have listings in Indiana's SERFF database for 2017...but neither of which has any actual filings listed. I presume these are placeholders for them to potentially enter the state market, which would be a good thing (and which Aetna has already indicated they might be doing next year). In addition, Golden Rule says that they'll be offering ACA-compliant policies starting next year as well (mainly for their current "transitional" enrollees).

The bad news is that while I've hunted down the current enrollment numbers for 5 of the 6 renewing carriers, one of them, MDwise, is frustratingly unknown, making it tricky to calculate a weighted average rate hike. Actually, I only have hard numbers for 4 carriers; for Celtic I had to cheat a bit by using their projected enrollment for next year. At 197,000 member months, that's an average of around 16,400 enrollees both on & off the exchange.

Without MDwise included, the average of the other 5 carriers comes in at 19.25%. However, MDwise is only (only is relative, I realize) requesting an 11.5% average hike, so any additional enrollees from them would bring that average down somewhat. The problem is figuring out how many current enrollees MDwise has:

Old people, generally speaking, require more medical care than young people. This isn't an absolute, of course; there are 60-year olds who can kick a 30-year old's ass, and while younger people tend to be healthier than the elderly, they also tend towards more risky behavior, be it reckless driving, bungie jumping or whatever. Still, the fact remains that there's a reason why insurance carriers lust after so-called "Young Invincibles" so much: They tend to be relatively low-risk and inexpensive to treat when something does come up.

The conventional wisdom when it comes to taxes is that Republicans are always for cutting 'em while Democrats are always for raising 'em. The reality, of course, can be far more complicated--it's not just about cutting or raising taxes, it's also about who's getting the increase/decrease and what the money would/no longer would be used for. Even so, this is an odd-sounding story at first glance.

Just last week, the Big News Shocker out of Oklahoma was the blood-red Republican-controlled state legislature and governor were actually considering a) raising taxes (!!!) and b) expanding Medicaid via the ACA (!!!) in order to dig themselves out of their self-dug financial hole:

So, in what would be the grandest about-face among rightward leaning states, Oklahoma is now moving toward a plan to expand its Medicaid program to bring in billions of federal dollars from Obama's new health care system.

What's more, GOP leaders are considering a tax hike to cover the state's share of the costs.

The survey also finds a lack of awareness about new rules for coverage introduced by the ACA. Among all those with ACA-compliant coverage, fewer than half (47 percent) know that preventive services are covered completely by their plans, while a third (33 percent) think that copays or deductibles apply to preventive services and one in five (20 percent) are not sure. Among those in high-deductible plans, awareness is even lower: 41 know that preventive services are covered with no cost-sharing.

The Kaiser Family Foundation has just released their 3rd Annual survey of people enrolled in the "Non-Group Health Insurance Market", otherwise known as the Individual market. It's important to note that this survey includes Americans enrolled in all individual market plans, both on and off-exchange. There are technically 5 separate categories, although they can effectively be merged into three categories for most purposes:

A source who doesn't wish to be named attended the annual meeting of the Wisconsin Common Ground Co-Op the other day (Common Ground is one of the 11 Co-Ops which survived last year's Risk Corridor Massacre), and forwarded a few tidbits of info:

CG is open to considering outside investment funding now that CMS is allowing the Co-Ops to pursue it, but isn't scrambling to seek it out just yet. They did note that Wisconsin has a law applying to the Co-Op which requires that all board members use it for their own insurance (which makes total sense, actually). Since any outside investor would likely be on the board, they'd also have to utilize CG coverage.

I was also provided with an image of their overall financials for 2015 (see below). They didn't have much to say about this year since it's only May but seemed comfortable with how things are proceeding so far, and said their MLR (medical loss ratio) is "dropping" although from what to what I have no idea.

UnitedHealth Group is pulling out of New Jersey’s Obamacare marketplace in 2017.

The company’s subsidiary, Oxford Health Plans, will stop offering individual plans on the state’s federally facilitated health insurance marketplace, according to a letter from the state Department of Banking and Insurance.

The letter was obtained by POLITICO through an Open Public Records Act request and the company later confirmed it will not offer exchange plans next year.

“Individuals impacted by these decisions will continue to have access to their current health benefits until the end of 2016, when they will need to pick new plans for 2017. Our small and large group business, Medicare and Medicaid businesses will not be impacted by this decision,” the company said in an emailed statement.

The good news is that it's easy to use, and lists all of the carrier rate hike requests in a clearcut manner...except, oddly, for CHRISTUS, which I'm pretty sure is being offered this year.

The bad news is that it doesn't include any of the actual market share/enrollment numbers, making it impossible to come up with a weighted average. Some of these are available via redacted filings over at the federal RateReview.Healthcare.Gov site, but not all of them. I have New Mexico Health Connections estimated at 48,000 based on this report, but I have no idea how many CHRISTUS or Presbyterian enrollees there are.

The RateReview site lists CHRISTUS as ranging from 9.4 - 15.2%, but without market share numbers I can't even come up with a proper rate hike request, so I've split the difference for now at 12.3%.

Well, now...this is about as cut & dry as it gets! They don't display the actual enrollment numbers for each carrier, but that's OK because the only real reason I need it in the first place is to weight the increases by market share...which the New York Dept. of Financial Services has helpfully already done!

And there you have it: A weighted average requested rate increase of 17.3% across the entire state's ACA-compliant individual market. Remember that NY never allowed transitional plans anyway, and there are likely only a handful of grandfathered plans left on the individual market, so this should cover well over 90% of the market.

They also included the Small Group market, which I take note of when available but don't really track nearly as closely as the indy market:

Many single payer advocates have been either confused or angry with me (to put it mildly) for not being a fan of Bernie Sanders's proposed national SP plan.

I've explained repeatedly that while I am a SP proponent, I just don't see it happening at the national level all at once. There are too many barricades and too many logistical, economic and political problems in doing so to make it remotely feasible to bring SP to the country in this fashion. In addition, I have major problems with the utter lack of detail in Bernie's plan.

HOWEVER, I've also repeatedly stated that I do strongly support getting the ball rolling at a smaller level first--either by partially expanding existing SP programs such as (Medicare, Medicaid, CHIP); consolidating existing private systems into larger risk pools (ie, merging the risk pools of the individual & small group markets, as a few states have done already); and/or by getting SP enacted at the state level, then using that as a model for other states and/or as a national model if it works out.

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For 2017, UnitedHealthcare, along with most of its subsidiaries, is discontinuing its participation in the individual market in Colorado, both on and off the exchange. However, Golden Rule Insurance, a subsidiary of UnitedHealthcare, will continue to offer its individual plans in Colorado off of the exchange. UnitedHealthcare will also continue its small and large group business in the state.

Humana will continue in the small group market for 2017 off the exchange, while exiting the individual market for both Humana Health Plans and Humana Insurance Company.

Last month I noted that, assuming I was reading Connect for Health Colorado's monthly dashboard report correctly, they were down to 115,890 effectuated exchange enrollees as of 3/31/16, or a whopping 23.1% lower than the official APTC report tally of 150,769 QHP selections as of the end of Open Enrollment.

...The 121,962 number at the top seems to be the one I want...except that it also includes SHOP and standalone Dental enrollments (I think).

...OK, so 121,962 includes SHOP, which has a maximum tally of 2,897, which means that the effectuated number as of 4/30/16 could be as low as 119,065...except that "Individual" could also potentially include standalone dental plans, confusing the issue further. Even worse, it says that this "Includes those who effectuated in the current plan year and later terminated a policy".

I can't tell whether that means that those who terminated their policies have been subtracted from the total (accounted for) or if they're included in the total (cumulative).

Despite bitter resistance in Oklahoma for years to President Barack Obama's health care overhaul, Republican leaders in this conservative state are now confronting something that alarms them even more: a huge $1.3 billion hole in the budget that threatens to do widespread damage to the state's health care system.

So, in what would be the grandest about-face among rightward leaning states, Oklahoma is now moving toward a plan to expand its Medicaid program to bring in billions of federal dollars from Obama's new health care system.

What's more, GOP leaders are considering a tax hike to cover the state's share of the costs.

"We're to the point where the provider rates are going to be cut so much that providers won't be able to survive, particularly the nursing homes," said Republican state Rep. Doug Cox, referring to possible cuts in state funds for indigent care that could cause some hospitals and nursing homes to close.

OLYMPIA, Wash.– Thirteen health insurers have filed 154 individual health plans for 2017 both inside and outside of the Exchange, Washington Healthplanfinder. The average requested rate change based on enrollment is 13.5 percent.

...United Healthcare, the nation's largest insurer but a bit player in Maryland, was not included on a list released Friday by state regulators of companies seeking rate increases for 2017.

Insurance Commissioner Al Redmer confirmed that the company was leaving the exchange created under the Affordable Care Act, as it has in most states across the country. It will continue to offer plans in the small-business market.

The dominant carrier on the individual market in Iowa is Wellmark BCBS, which had 137,000 enrollees (something like 75% of all the market) last year.

However, there were two important caveats to that: First, Wellmark isn't currently participating on the ACA exchange; all of those enrollees were off-exchange only. Secondly, at the time I had no idea how many of them were ACA-compliant and how many were "grandfathered" or "transitional" policies, which aren't ACA compliant and which, more significantly, aren't part of the same risk pool.

Fifteen health insurers want an average 17.7 percent increase in premiums for Affordable Care Act individual plans, Florida officials said Thursday — higher than last year’s approved average of less than 10 percent.

...In Florida, 15 companies also asked for an average 9.6 percent increase for small group plans, said Amy Bogner, spokeswoman for the state’s Office of Insurance Regulation.

The companies were not identified individually because they claimed trade secrecy, she said.

Regular readers know that I spent countless hours last summer tracking down the requested average 2016 rate change filing forms for every single state in the country, and then compiling them into my best guesstimate about the overall, weighted average rate changes for the individual policy market in each state and nationally.

As it happens, I turned out to be pretty much dead on target: The "presumptive" average (ie, assuming every single enrollee stayed with the same policy whenever possible) ended up being 11.6% nationally, while the effective average ended up being 8%.

Just hours after the Obama administration on Friday stood up for transgender students, it took unprecedented steps to protect transgender patients.

Transgender people must be provided transition-related services and cannot be denied healthcare by providers or professionals who receive federal funding, according to a final rule announced Friday by the U.S. Department of Health and Human Services. The rule specifically bans the denial of coverage or healthcare itself on the basis of gender identity.

The rule, which comprises several regulations, was formed under Section 1557 of the Affordable Care Act, which includes first-of-its-kind civil rights protections in healthcare for several classes of people — including a ban on discrimination on the basis of sex.

Kansas health insurance marketplace may gain company offerings for 2017

TOPEKA, KS — Ken Selzer, CPA, Kansas Commissioner of Insurance, said today that Kansas health insurance consumers may have additional company options for coverage in the federallyrun marketplace for 2017.

“Health insurance options filed now for the individual market show that competition will likely continue for Kansans’ health insurance policies,” Commissioner Selzer said.

Filings with the Kansas Insurance Department as of May 2 show two additional carriers may participate in the marketplace. Medica, a non-profit, Minnesota-based company, and Coventry Health and Life are companies that have filed for the 2017 open enrollment period.

Medica Insurance Company is set to offer a number of plans, and Coventry is proposing Exclusive Provider Organization (EPO) Network plans. Both companies have filed to offer plans off the federally-facilitated marketplace as well.

As I've noted the past few months, unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fullly Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.

The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day. Presumably they didn't have 17,000 people enroll in a mad rush on February 1st, so there's an odd discrepancy here, but whatever.

The House followed the Senate’s unanimous approval of SB 865, sponsored by Sen. David Sater, with a 140-6 vote, moving the “Health Insurance Rate Review” bill to the Governor’s desk on Tuesday.

In addition to rate review, the bill will modify provisions regarding licenses issued by the Board of Pharmacy and covered prescription benefits, delineates procedures for PBMs with regards to MAC lists, and requires health carriers to offer medication synchronization services.

The advancement was cheered by Missouri Health Care for All (MHCFA), who believe the bill will bring more transparency to insurance premiums.

Chad Terhune reported today that Covered California, the largest state-run ACA exchange in the country, released their 2016-2017 fiscal year projected budget, which includes a mountain of useful enrollment data...some of which is positive, some negative and some of which depends on your POV:

California’s health insurance exchange estimates that its Obamacare premiums may rise 8 percent on average next year, which would end two consecutive years of more modest 4 percent increases.

Long-time readers know that ever since I started this project in 2013, I gradually added and enhanced the healthcare coverage data that I was tracking. First it was exchange-based QHPs only; then I added (or separated out) Medicaid expansion, SHOP (small business) exchange enrollment, off-exchange individual policies and so on. The off-exchange numbers were always significant but spotty because most insurance carriers are very cagey about breaking out their membership in too much detail if they don't have to, and many state insurance departments don't bother to track (or at least publicly report) those numbers.

SHOP enrollment, on the other hand, should be very cut and dry. Like exchange-based individual QHP enrollments, there's no reason why these shouldn't be included in every regular exchange enrollment report, and several of the state-based exchanges do just that...although in some cases, even that's a bit fuzzy. For instance:

Just yesterday, the Urban Institute released a detailed analysis of Bernie Sanders's "Medicare for All" plan, which would actually be far more comprehensive than Medicare is, not just in terms of how many Americans it would cover (everyone!) and what percentage of costs it would cover (everything!) but also in terms of what ailments/services it would cover (all of them!).

Their conclusion was that such a policy would cost over twice as much as Senator Sanders claims (around $32 trillion over the next decade on top of what the federal & state governments currently spend, versus the $13.8 trillion that Sanders estimates). Their conclusion was even more expensive than the $24 trillion estimate from a prior analysis by Kenneth Thorpe (the guy who put together Vermont's failed single payer proposal a decade ago).

When UnitedHealthcare announced last month that they were making good on their threat last fall to pull out of the individual market in over two dozen states next year, it caused shockwaves across the health insurance industry. It is an important development, as around 800,000 people will be impacted.

At a campaign stop Monday in Northern Virginia, Hillary Clinton reiterated her support for a government-run health plan in the insurance market, possibly by letting let Americans buy into Medicare, to stem the rise of health-care costs.

Today, with the 2016 enrollment period several months behind us, I just realized that I completely forgot to mention that yes, I've once again made arrangements to keep at it for a fourth year: I'll continue to track ACA enrollments as well as related ACA/healthcare data developments (Medicaid, BHPs, premium rate hikes, etc etc) for another full year, through at least April 2017.

However, those arrangements only cover a portion of the time and effort it takes to maintain everything here at ACASignups.net...the Spreadsheet, the Graph, and especially the blog.

Some regular visitors have been very generous in the past, so I'm not directing this at them...but for those who haven't yet done so, and who appreciate the data, analysis and discussion here at ACA Signups, I'd greatly appreciate any donation you might be able to spare to help keep it operating.

On the one hand, the open enrollment period itself may seem to be getting almost...boring. Most of the technical issues have been worked out and people are getting more and more used to the process. Dramatic Supreme Court decisions like King vs. Burwell and Hobby Lobby are now behind us.

I'm a long-time single payer advocate (although I'm willing to accept something short of it). I've long admired Bernie Sanders as a Senator. And while I was generally leaning towards supporting Hillary in the primary, I was very open to being persuaded to Feeling the Bern. One of the big things which I was hoping would be the tipping point was Sanders's much-anticipated official Single Payer plan (as opposed to one of the earlier ones he had previously proposed in past years). This was supposed to be the culmination of 30+ years of single payer advocacy from a major presidential candidate who was making that proposal one of the cornerstones of his entire campaign. Expectations were high here, and if I had been impressed by the plan itself (even as a rough "white paper" outline), I was ready to jump on board.

I've writte a lot about the so-called "woodworker effect" with Medicaid expansion over the past 2 1/2 years: People who were already eligible for Medicaid before the ACA, but who never signed up for it for a variety of reasons (they didn't know they qualified; didn't know the process for signing up; were too embarrassed to do so; etc etc). I estimated about 3 million "woodworker" enrollees in 2014, although I downshifted that later on and now have the tally estimated at around 3.8 million nationally as of the end of 2015. That's a lot of people being added to the system who would have been eligible for Medicaid even if the ACA had never been passed.

I haven't written much about West Virginia, and the last time I addressed their Medicaid expansion data was way back in September 2014, when they hit around 150,000 enrollees...or 100% of the total number thought to be eligible for the program.

Either those estimates were off, or the economic situation has changed over the past year or two. It's also conceivable that the state has deliberately nudged some "traditional" Medicaid enrollees over to "expansion" status in order to save money (remember, the federal government only pays 74% of the cost of "traditional" Medicaid, but 100% of expansion, though this gradually drops to 90% over the next few years).

Last month I noted that, assuming I was reading Connect for Health Colorado's monthly dashboard report correctly, they were down to 115,890 effectuated exchange enrollees as of 3/31/16, or a whopping 23.1% lower than the official APTC report tally of 150,769 QHP selections as of the end of Open Enrollment.

Over the weekend, they released their April dashboard report, and the numbers are actually up slightly...which means that while the net drop compared to the OE3 number is still steep, it's also spread out over a 3 month period instead of 2:

As I noted at the time, normally, all 90 panels are chosen by a NN committee, but this year they decided to leave 10 slots open to “public voting”, allowing anyone to create a NN account, log in and vote daily for their favorite panel.

Throughout last September and October, I chronicled the dominos-like downfall of a dozen ACA-created Co-Op insurance carriers. They tumbled, one by one, as a result of a perfect storm of problems, some of which dated back to the final version of the ACA which was signed into law; others which cropped up along the way:

Conrad's plan called for $10 billion of government grants distributed among nonprofit, member-owned health insurance startups. The money came with few restrictions. Competing against big for-profit insurers is difficult, Conrad said. The co-ops needed as much freedom as possible to ensure their survival.

Republican lawmakers maneuver to force a vote on KidsCare, reviving a debate over the role of government in people's lives vs. personal responsibility

Chastened and angry over their failure to reinstate KidsCare, Republican lawmakers in the Arizona House got Democrats to join them Thursday in a successful bid to revive the children’s health-insurance program.

May 15 officially marked the start of the 2016 rate review season. What that means for Americans is that over the next month or so, newspapers and web sites across the country will start running stories with scary-sounding headlines like this:

The articles will throw a bunch of numbers around, saying that the “average” premium rate increase for a given state is expected to be X percent, followed by examples of the highest and lowest increases. There may even be a few “Company Y will actually be reducing their rates!” thrown in.

This is really just a summary of my last 4 posts. I've combed through the SERFF databases for every state which uses the system for rate filings, and while very few have the actual 2017 rate filing requests listed yet, at least 4 of them have official individual market exit letters submitted for 2017 from Jane Rouse, the Product Compliance Process Owner for Humana Insurance Co:

This list may grow as additional state filing data and/or press releases come out from Humana, but assuming these are the only 4 states Humana is bailing on, the news isn't quite as bad as it appears at first.

To be clear, I'm not saying this is a good development; when you combine it with the recent UnitedHealthcare Dropout Odometer it's more of a drip-drip-drip sort of thing. But it isn't disasterous for the exchanges either (at least not yet).

UPDATE: I've been informed by a reliable source that Humana is also dropping out of the individual market in Nevada next year, although I don't have any actual enrollment data there. Humana is not currently participating on the Nevada exchange, however, so any dropped enrollments would be OFF-exchange only. In fact, I'm pretty sure that the only individual market enrollees Humana has in Nevada are grandfathered policies anyway, so the numbers should be pretty nominal there.

According to the ASPE report, as of 1/31/16, 200,691 people had selected QHPs via the WA exchange. This is completely consistent with the exchange's own final report of "more than 200,000".

However, according to their March monthly enrollment dashboard report, the Washington HealthplanFinder only had 176,914 people having "Selected a Plan" as of February...and of those, only 156,493 were reported by the carriers as having paid.

That payment rate is a quite reasonable 88.5%, which is slightly lower than my general 90% rule of thumb estiamate nationally but not out of line at all. However, what's the deal with that 177K topline figure? Where did the remaining 23,777 people go?

As previously disclosed, in the fourth quarter of 2015 the company recorded a PDR associated with its 2016 individual commercial ACA‐compliant offerings. Historically, this business has reported a profit in the first quarter of the year due to the related benefit designs. Because the company continues to anticipate a loss associated with this business for the full year 2016, the seasonal earnings generated in 1Q 2016 are offset by an increase in the PDR, resulting in a higher benefit ratio year over year. This first quarter seasonality was anticipated as the company developed its estimate of the full‐year PDR recorded in the fourth quarter of 2015.

Financial results associated with the wind‐down of the non‐ACA compliant (legacy) business, including the related release of policy reserves, as well as indirect administrative costs associated with ACA‐compliant offerings are included in the company’s 1Q 2016 financial results.

A few weeks ago, I got a heads up that Virginia was the first state out of the gate with their 2017 Rate Request filings. There were some confusing numbers which took awhile to sort out, but once the dust settled, the overall weighted average rate hike requests for Virginia's entire ACA-compliant individual market came in at around 17.9%.

Some states make it next to impossible to track down this info. Others hand it to you on a silver plate. And then there are states like Oregon, who provide the average rate hike requests in a simple, easy format, but don't necessarily include the market share of those companies, making it difficult to compile a weighted average:

Back in January I noted that Moda Health Plans, which had plenty of self-inflicted wounds in addition to being kneecapped by the Risk Corridor Massacre, was dropping out of the Oregon exchange and likely the Alaska exchange as well, so today's news isn't a big surprise.

The individual market in Alaska has just two carriers in 2016: Moda and Premera. Both have struggled with significant losses under the ACA, and Moda nearly exited the Alaska market altogether in late January (more details below).

Finally, on the Medicaid spreadsheet, I've gotten as close as possible to an accurate count of the number of new Medicaid/CHIP enrollees which are PURELY due to ACA Expansion. To achieve this number, I took the total number of new enrollees and first removed the 25 states which haven't expanded Medicaid at all. This leaves 26 states (including DC). Then, I used Washington State as a guideline for the split between "ACA Expansion Only" and "Out of the Woodwork" enrollees (ie, people who were previously eligible pre-ACA but didn't enroll until after October 1st for various reasons). Washington has had a pretty consistent ratio of 2/3 Expansion Only to 1/3 "Woodworkers". I have no idea if that's representative of the other 25 states, but it's the best I can do for now. Note that this still also includes those who are newly eligible...but under the old Medicaid rules (ie, someone who simply fell on hard times after October 1st).

Gov. Rick Snyder said Tuesday he will seek permission from the Obama administration to allow all young people in Flint the chance to receive publicly funded health care services for lead exposure amid the city's contaminated drinking water crisis.

...The White House and federal Department of Health and Human Services did not have an immediate response Tuesday to Snyder's initiative targeting Flint residents up to age 21 through the expansion of Medicaid.

Even then, he wasn't exactly in a big hurry to do so; he waited another 3 weeks to get around to actually submitting his request:

I was fascinated when I saw this phenomenon happen here in Michigan last year, but it's repeated itself in several other states since then. State and federal officials crunched their demographic data and came up with estimates of the maximum number of residents who they expected to be eligible for the ACA's Medicaid expansion provision a couple of years back, along with the number of those expected to enroll in the program in the first year. They're then caught offguard when not only does the actual number eligible turn out to be far higher than they expected, but far more of those eligible go ahead and sign up in the first year than expected.

In Michigan, estimates ranged from 477K - 500K being eligible; instead, the number broke 600,000 the first year, where it's hovered around ever since (as of last week it stood at 615,536).